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Coal’s Deadly Dust

I've mowed that bank right there since I was a little boy. Lord, 8 or 9 years old. It's just a simple task to most people, but to me this is something, it's like a, a challenge that you have to get through. I believe fully if, if I hadn't really got up and started moving around because I was so sick, I would have sat in my chair and died. And, and things like this right here, I get up and it gives me, I, I motivate myself to do it.

HOWARD BERKES, Correspondent, NPR:

[voice over] During the past six years, I’ve been in and out of the coalfields of West Virginia, Virginia, Kentucky and Pennsylvania, meeting sick and dying coal miners. At first, I reported for NPR the resurgence of a deadly coal mining disease – black lung – which had been declining for decades. Then I got a tip two years ago about an outbreak of the most advanced form of black lung disease and I began looking into why it was happening.

HOWARD BERKES:

[on camera] So this morning we're headed to visit with Danny Smith. He's a young guy. He's younger than what you'd expect for somebody to be so sick with this disease.

So you said you had a rough time last night?

DANNY SMITH, Former miner:

Yeah. I sleep in my chair.

HOWARD BERKES:

So you sleep out here in the living room in, in a chair?

DANNY SMITH:

Most of the time I sleep in a recliner, yeah.

HOWARD BERKES:

[voice over] Danny Smith is just 47 years old. He mined coal only 12 years, but he’s desperately sick.

DANNY SMITH:

Are you ready, Sissy?

SAMANTHA, Danny’s daughter:

Yeah.

DANNY SMITH:

Well, let daddy turn his oxygen off and I'll get my stuff ready and we'll go.

DANNY SMITH:

[voice over] I started getting shortness of breath around 2007, 2006. I could, I could tell a difference in just the things that I was doing around here.

SAMANTHA:

Do you want me to get this?

DANNY SMITH:

The oxygen? Yeah, I need it.

DANNY SMITH:

[voice over] And in 2012, I believe it was, they'd done a CT scan, and they seen all the spots on my lungs. They said, “It's black lung. You're eat up with black lung.” They put me in a hospital. I had 30-some pounds of fluid on me, on my lungs.

I'm not feeling good today, baby. Didn't sleep good.

DANNY SMITH:

[on camera] I was scared. It was tough on all of us because my wife was scared that I was dying, and I was scared that I was dying, and I was.

Can you turn that oxygen on back there? Just pull that little green handle. Just pull it like toward you. There we go. Now I gotta get it on my face.

DANNY SMITH:

[voice over] I think about all the hours that I worked. I was under one mine, I never come outside for four days. I actually slept underground. And you sit and think about that and all the things that I give up with my family. You know, I’m working anywhere from 12 to 18 hours a day. I'm dying over it now. You know what I'm saying?

DANNY SMITH:

[on camera] I love you. Give me a kiss!

HOWARDBERKES:

[voice over] As I met more miners like Danny Smith, it became clear that they were getting this advanced black lung disease younger and more quickly than in the past.

HOWARD BERKES:

[on camera] Greg?

GREG KELLY, Former miner:

Hey.

HOWARD BERKES:

[on camera] I'm Howard Berkes from National Public Radio. Great to meet you.

HOWARD BERKES:

[voice over] Greg Kelly is just 54 years old, still relatively young for a miner so sick.

GREG KELLY:

That’s me and that’s my stepdad.

HOWARD BERKES:

How long did you spend in mining?

GREG KELLY:

31 years. Here’s one. That was in ’83.

HOWARD BERKES:

And what made you stop mining?

GREG KELLY:

My health. I just couldn't, I got sick and they said, “We don't want you to go back to work till you see a lung doctor.” When I did get to see him, he said, you know, “You don't need to go back underground.”

HOWARD BERKES:

Was that the first time you learned that you had black lung?

GREG KELLY:

Right. Yeah, that's the first doctor that ever said, you know, “You've got black lung.” I've had two or three X-ray technicians tell me they're the worst set of lungs they've ever seen.

HOWARD BERKES:

What kind of reaction did you have when you heard about that?

GREG KELLY:

You can't work. It's just like a light switch being turned on and turned off. All your plans as you had, you know, hunting and fishing and doing what you want to do. When that day comes, well, all of a sudden it's here and you can't. You don't have the air to do it.

GREG KELLY:

[voice over] You know, I still enjoy life. I have a good time. Get to play with my grandson, just not like I want to and like I used to be able to, you know.

GREG KELLY:

[on camera] You catch one? There he is, you got it.

GREG KELLY:

[voice over] Well, I just try to pray and ask the Lord to help me overcome it and just go on and, and be with my family.

GREG KELLY:

[on camera] You got one, didn't ya?

GREG KELLY:

[voice over] The whole time I'm bent over, I can't breathe. And then when you rise up, you, you got to just stand still to get your breath.

GREG KELLY:

[on camera] Come on, let's go show mom what you caught.

JOSHUA KELLY, Greg’s son:

It was kind of rough because I was in Texas when a lot of it first happened, being, you know, pretty far away from home. And Caden, he had to adjust with when he had, when he first brought oxygen home and whatever, and Caden asked, “When's he gonna get better? You know, when's he gonna be able to go out and play like we used to?” And that's when we had to tell him, you know, “It, it never will change. You know, it'll be the same. It won't get no better.”

GREG KELLY:

[on camera] That's probably been the hardest ordeal, is my grandson.

NPR REPORT:

The disease that steals the breath of coal miners is back with a vengeance.

HOWARDBERKES:

[voice over] Across Appalachia, I met dozens of other miners with this advanced black lung disease and started reporting their stories.

Basic black lung diagnoses doubled in the last decade. Advanced disease quadrupled since the 1980s in Virginia, West Virginia and Kentucky.

HOWARD BERKES:

[on camera] One in five working coal miners in Appalachia could have diseased lungs. That’s true for the thousands who’ve been tested and it could be the rate for the rest.

HOWARD BERKES:

[voice over] The more I reported, the more it became clear it was worse than anyone realized. Go see Brandon Crum in Kentucky, I was told. He’s a radiologist whose clinic is overwhelmed with cases of advanced black lung disease, known as progressive massive fibrosis or PMF.

BRANDON CRUM, M.D., Eastern Kentucky Medical Group:

So I'll just show you for comparison. This is a normal X-ray. And you can see all the dark area – that's the lung ’cause it's filled with air. And you contrast that to this one. All, you see all these big white areas, all the way through here? That's all conglomerate fibrotic mass or PMF.

The biggest concern at that time for me was seeing young men my age – and I'm, I’m 43 – or, or younger than I am with the most severe form of the disease, which is the complicated black lung disease.

HOWARD BERKES:

[voice over] Crum was so concerned, he took his findings to researchers at the National Institute for Occupational Safety and Health or NIOSH.

HOWARD BERKES:

[on camera] So what happened two years ago in terms of you sitting down with people from NIOSH?

BRANDON CRUM:

Well, when I told them, you know, we were seeing or I was seeing a lot of, of complicated black lung disease, and, and what was most concerning is I was seeing it in individuals in their 30s and 40s, I think there was some hesitancy on their part. I'm not sure they believe me.

SCOTT LANEY, Ph.D., Epidemiologist, NIOSH:

He told us that he was seeing a lot of really advanced disease and it was concerning to him, and I guess my initial thought was: That's probably not true.

HOWARD BERKES:

[voice over] The researchers had been tracking black lung disease themselves for decades. But they only tested working miners – not those out of work – and hadn’t detected the sharp rise in deadly PMF that Brandon Crum was finding.

SCOTT LANEY:

He invited us to show us some of the, the medical images from his patients. And we sat there for an entire day, one after another after another, looking at these chest X-rays, the worst I've ever seen.

HOWARD BERKES:

[on camera] What was your reaction to what you saw?

SCOTT LANEY:

Horror. Shock. I don't know how the, many other words to, to use. I, I was really taken aback, not only that these cases were legitimate, but just how severe they were. It indicated that we had a huge problem, and we realized immediately that it wasn't going to be isolated to a single clinic.

HOWARD BERKES, Correspondent, NPR:

Researchers at NIOSH had only reported 99 cases of PMF in the previous five years. But out of work miners had been flooding clinics. And in calls and visits to 16 clinics across Appalachia, FRONTLINE and NPR identified close to 2,000 cases in the same time frame.

HOWARD BERKES:

[voice over] The Stone Mountain clinics in Southwestern Virginia reported more cases than anyone. Ron Carson directed the clinic at the time.

RON CARSON, Former director, Stone Mountain black lung program:

We're gonna put you in a room. Come on with me. When NIOSH reported maybe 90 or 100 X-rays…

CLINIC STAFF:

All right, if you’ll step up real close for me.

RON CARSON:

So we came back and we started doing a study on how many we actually had, pulling X-rays back to 2014 to 2017, three years of X-rays. We quickly identified 416 during that three-year period. However, if we had went back to 2010 at a minimum, we could have probably doubled that.

CLINIC STAFF:

Breathe in and out deep and fast. In and out. And stop.

RON CARSON:

And I don’t know what your test will reveal today. But, and I tell everybody this for almost 30 years: Don’t get discouraged.

HOWARD BERKES:

[voice over] But the count here at Stone Mountain is now nearly 800, with a dozen new cases a month.

RON CARSON:

My buddy here. Give me a hug. God bless you.

RON CARSON:

[voice over] I just think that America needs to know that these miners, they have paid a price. So many years, these miners extract this coal…

RON CARSON:

[on camera] …so that you and I can… I'm getting teary-eyed. I'm sorry. They paid a price. They have paid a price so that we can have luxury.

RON CARSON:

[voice over] And I just feel like America has just forgotten about them.

PREACHER:

So let us trust in you and you only. Despite what's going on around us, give us the joy and the peace that the world cannot give us. And we thank you for your love that is unconditional. In Jesus’ name, we pray. Amen.

HOWARD BERKES:

[voice over] With no cure, Danny Smith finds some help with his breathing at a pulmonary rehab clinic. Miners come here as much as four days a week and they’re monitored closely.

Danny, when he first started with us, he would break out in a cold sweat, literally drenched, and he would start shallow breathing. Depression, anxiety, you know, that is, that is [as] much a part of this disease as the breathing is.

And we’re going to turn it way down. OK?

DANNY SMITH:

All right. That feels pretty good right there.

MARCY TATE:

[voice over] It takes them approximately three to six months to build up when they start this program. At six months they're typically maxed out. If they're out for two weeks, they lose pretty much everything they gained.

MARCY TATE:

[on camera] Once they go in…

DANNY SMITH:

If I miss one or two visits I can tell. I mean, it's affected me.

MARCY TATE:

[on camera] You did it! 10 minutes!

DANNY SMITH:

I got it.

MARCY TATE:

[voice over] These men, literally, if they go home and they sit down, they've got about six months to live.

DANNY SMITH:

If I hadn't started here, I'd already been dead.

MARCY TATE:

He would have. I believe that, too. I do.

DANNY SMITH:

I love you all. Y’all are angels. See y’all.

ROBERT COHEN, M.D., Pulmonologist, University of Illinois at Chicago:

When people get the first stages of the disease, they require oxygen and then even the oxygen that you're adding to that person so that they can do more isn't enough. And so they're essentially suffocating while alive. Something seemed to change where people were more heavily exposed to perhaps more toxic dust. And we're getting this very severe form of the disease that, from my medical school training and from my past clinical practice, was rare. We didn't see that many cases of PMF and it was something that we thought had been relegated to the trash heap of history.

HOWARD BERKES:

[voice over] The modern era of coal-mine regulation began nearly 50 years ago, in part because 40,000 coal miners staged a wildcat strike in West Virginia, demanding government action on black lung.

KEN HECHLER, West Virginia congressman, 1959-1977:

The greatest heroes are you, the coal miners. You've taken the future, your future, in your hands and you have proclaimed, “No longer are we gonna live and work and die like animals. We're free men!”

HOWARDBERKES:

[voice over] Congress responded with a tough new law that was supposed to protect miners from the coal-mine dust that poisons lungs. And in the early ’70s, a new federal research agency, NIOSH, began to monitor black lung disease among working miners.

ROBERT COHEN:

We saw a nice reduction in the rates of disease falling down to very low levels. And then that, I call it the U-shaped curve of concern. The curve went down and hit the bottom and then started to go back up again, meaning that something changed. We took our eye off the ball, something else happened, and the disease was recurring.

HOWARDBERKES:

[voice over] What changed was mining itself. Big and pure coal seams were mined out. Thinner seams embedded in rock were left. Mining machines cut more and more of that rock producing fine and sharp particles of quartz or silica – toxic dust that the existing mining regulations didn’t directly control.

ROBERT COHEN:

Somewhere in the late 20th century there has been a change in the composition of the dust. We're seeing more silica and silica is 20 times more toxic than coal. When you inhale silica, it's retained in the lung. These miners are inhaling their workplace and it stays with them forever.

HOWARDBERKES:

[voice over] By the mid 1990s, federal regulators knew there was a problem. NIOSH recommended new silica regulation, including an exposure limit twice as tough. But the proposals didn’t go anywhere.

HOWARD BERKES:

[on camera] So you worked for the agency back in this time frame.

CELESTE MONFORTON, Mine Safety and Health Administration, 1995-2001:

Mm hmm.

HOWARD BERKES:

Why didn't the agency respond to this?

CELESTE MONFORTON:

There was a lot of reluctance, both in the mining industry and I think also with, from the Mine Workers Union, about the, what they would call complexity of really doing both a coal-mine dust standard and a silica standard. Now we see in miners who were again working at that period of time and now are the ones that are seriously ill from that disease.

HOWARD BERKES:

They're dying.

CELESTE MONFORTON:

Yeah.

HOWARD BERKES:

Terrible deaths.

CELESTE MONFORTON:

Yeah. Had we taken action at that time, I really believe that we would not be seeing the disease that we're seeing now.

HOWARDBERKES:

[voice over] It wasn’t until 2014 that the Mine Safety and Health Administration, MSHA, put in place new restrictions on coal mine dust. But again, something was missing.

HOWARD BERKES:

[on camera] This is the new dust rules that took effect in 2014. What's interesting is this section here where MSHA said it wasn't establishing a new limit for quartz or silica.

HOWARDBERKES:

[voice over] Instead of imposing specific new limits on silica dust, regulators continued to rely on rules that control coal-mine dust overall and a complex formula to measure exposure that dates back decades. We decided to see if this approach had really worked, using MSHA’s own data.

HOWARD BERKES:

[on camera] This is the formula that is actually still in use. And what our data shows, what MSHA’s data shows, is that that formula hasn't worked 9,000 times since 1986. We can see it in the data. It's kind of puzzling why they didn't see it in the data and why they don't this is important enough to have a different kind of regulatory process.

GREG MEIKLE, MSHA Chief of Health, Coal:

We do have a new respirable-dust rule. I, I say it's new. It's 2014.

HOWARD BERKES:

[voice over] Greg Meikle is responsible for coal miners’ health at MSHA. I sought interviews with him and other agency officials for months, without any success, until this annual West Virginia black lung conference.

HOWARD BERKES:

[on camera] Greg, I'm Howard Berkes from NPR and PBS FRONTLINE.

GREG MEIKLE:

Hi, Howard. I have not met you.

HOWARD BERKES:

We have not met, but I have wanted to talk to you and I'm going to take advantage of that right now. You said that you need to establish an incident rate before you can respond as a regulatory agency. What do you mean exactly?

GREG MEIKLE:

Well, incident rate is how many miners. If we have no miners that are diseased, then the protections are effective.

HOWARD BERKES:

Well, you have lots of miners with disease. So that means the protections are ineffective?

GREG MEIKLE:

We've got a new rule. The old, old rule, we had some problems, and, and that's why we went to the new rule.

HOWARD BERKES:

The new rule doesn't measure separately for silica. That's what's still in place. That was what is, was in place in the old rule, and we have thousands of miners who have progressive massive fibrosis. Doesn't that need to be changed? If the problem here is silica, don't you need to separately regulate silica?

GREG MEIKLE:

Well, the, under, in the preamble to the new rule it said that quartz was not being addressed.

HOWARDBERKES:

[voice over] In the new rules, MSHA officials cited research that said coal-mine dust was the main factor in black lung and PMF. And they continue to stand by that idea: that limiting coal dust overall protects miners from excessive exposure to silica.

As for the coal mining industry, it once proposed focused regulation of silica, but mining companies continue to cut thin seams and create toxic silica dust.

BRUCE WATZMAN, National Mining Association:

We sympathize with those individuals, with those families. If we could turn back the hands of time we would do so to prevent this. But you know, we can't. We're dealing with historic exposures. And from our perspective what we need to be focused on today is: How do we prevent a recurrence of this?

HOWARD BERKES, Correspondent, NPR:

You've talked about the idea of looking ahead. But what we see as we look at data of exposures and it shows that there were thousands and thousands and thousands of exposures, not 30 and 40 years ago, but also 20 and 10 years ago. And the industry knew that mines were cutting more and more rock which was creating this silica. Why didn't the industry recognize what was going on and do something about it when it was taking place?

BRUCE WATZMAN:

Well, I don't, I don't think it's entirely fair to say that the industry didn't recognize and didn't do anything. You know, for a long period of time, we've been pleading, and I'll use that word, we've been pleading with the agency to allow us to use nontraditional controls for dust control.

HOWARD BERKES:

You can slow down the mining machines. You can maybe cut production a little bit so that you're not generating as much dust. Or maybe you decide that you don't cut so much rock. And you don't cut those thinner seams. Aren't those things that the mining companies could have done? You don't need regulation to do that.

BRUCE WATZMAN:

Sure, they could have done that. But again, Howard, I'm not going to speculate on why they did or didn't do what they chose. You know, our focus here is forward-looking. How do we prevent this in the future? I can't answer for those, what occurred in the past. Were we really focusing on the right thing? You know, MSHA had a, a mantra: End black lung. And we support that. But coal dust might not have really been where the focus should have been at that time. It might have been silica rather than coal dust.

HOWARD BERKES:

[voice over] For months, I’d been trying to talk to the head of MSHA about the PMF epidemic and the agency’s decisions to not directly address silica.

DAVID ZATEZALO, Assistant Secretary of Labor for Mine Safety and Health:

The MSHA mission is to prevent death, illness and injury from mining, and promote safe and healthful workplaces for U.S. miners. A very honorable mission.

HOWARD BERKES:

[voice over] David Zatezalo is a former mining-company executive who runs the agency. In September we tracked him to a rare public appearance here at West Virginia University.

DAVID ZATEZALO:

Silica is toxic to your body. You hear the phrase in health circles of a progressive massive fibrosis, these sorts of things. To me, I believe those are all clearly silica problems. Silica is something that has to be controlled.

HOWARDBERKES:

[voice over] I was surprised Zatezalo was so clearly connecting PMF to silica, and wanted to know why this hadn’t translated into direct action.

HOWARD BERKES:

[on camera] Mr. Zatezalo, I'm Howard Berkes from National Public Radio and PBS FRONTLINE. We've been interested in talking to you about progressive massive fibrosis and the epidemic of disease. I'm wondering why you're unwilling to speak with us about that. We've had multiple requests for interviews. Ready to talk to you today, next week, in the past.

DAVID ZATEZALO:

I don't think the science is that well-defined on it yet, Howard.

HOWARD BERKES:

[on camera] You have 2,000 miners right now with progressive massive…

DAVID ZATEZALO:

I don't, I don’t think that the science of the causation is that well-defined. I don't know.

HOWARD BERKES:

You said yourself that silica was…

DAVID ZATEZALO:

Could you… No, I said I suspect silica.

HOWARD BERKES:

We've interviewed dozens of coal miners and they've told us about their experiences. They, they all have progressive massive fibrosis. They're all dying from this disease. So they've talked about their experiences.

DAVID ZATEZALO:

OK, I'm supposed to go up here to this picture.

HOWARD BERKES:

Why won't you talk to us about this issue? Why…

DAVID ZATEZALO:

Because I don't think the science is settled on it.

HOWARD BERKES:

What does that got to do with it? You have so much experience in this field, as you just described, and you described all these deaths that are occurring.

DAVID ZATEZALO:

I won’t… OK, let me put it this way. I won't talk to you about it because I'm supposed to go be in a picture right now.

One of the things that just makes me angry is there's such a lack of urgency in the agency. It's abundantly clear in what we're seeing. This problem really is a silica problem and it's really why we're seeing such severe disease in miners. So we know the problem is silica dust, yet that's not what we're protecting miners against or our effort to protect them is utterly inadequate. I mean, I don't know how you can reach any other conclusion. And that is, I mean, this is such a gross and frank example of regulatory failure.

HOWARDBERKES:

[voice over] Given the time it takes for disease to appear, it could be a decade or more before we know whether the new coal-mine dust rules have made any difference. In the meantime, there are still more than 50,000 coal miners working nationwide.

HOWARD BERKES:

[on camera] When you come back here, do you feel, you know, pride or regret?

DANNY SMITH:

[on camera] A little bit of both, honestly. I was proud of working here. I was a young man and I was making good money. To sit back and look at it now, you know, they kind of molded us the way that they wanted to mold us. Buying us nice T-shirts and tools and hats all the time, and all these trips and stuff like that. It wasn't worth it, you know, because… And the bonuses and all that stuff. And we all worked our long hours and forsake our families for it. You know, it's tough. We was all young men. We was just kids but we worked hard. We killed ourselves here.

DANNY SMITH:

[voice over] We have a family cemetery and when you already got your plot picked out, at my age it’s kind of a scary thought, you know.

DANNY SMITH:

[on camera] I hope one day I get to see my grandchildren. I don’t want to talk anymore. OK? I’m sorry. Just give me a minute. I’m all right. If I can see my babies graduate from college, both of them…

Funding for FRONTLINE is provided through the support of PBS viewers and by the Corporation for Public Broadcasting. Major funding for FRONTLINE is provided by the John D. and Catherine T. MacArthur Foundation and the Ford Foundation. Additional funding is provided by the Abrams Foundation, the Park Foundation, The John and Helen Glessner Family Trust, and the FRONTLINE Journalism Fund with major support from Jon and Jo Ann Hagler on behalf of the Jon L. Hagler Foundation.